Blog

In this historical and cultural moment, sadly, anxiety has become a part of our everyday lives. Many of us experience nervous system “red alert” more often than we would like. I know I do, and I consistently see it in my clients. I am intellectually aware of the ways in which our bodies and minds try to protect us from threats. I also have a decent understanding of the ways in which these protection mechanisms often go haywire and end up creating or at least perpetuating a sense of threat instead. (Read here and here for two blog posts I wrote about trauma and the mind-body connection.) However, rational thought doesn’t help us when we get into a spiral of worry, panic and fear. For me, it can easily feel like my body and mind are betraying me, since I know I am not in danger and yet I FEEL like the world is caving in on me. I have been working on reframing this, so that my body is instead my best friend, a safe haven, the only little sanctuary that truly belongs to me on this earth. The idea is to calm the physiological signals using the body, so I can get myself out of sympathetic nervous system activation and realize that I am safe.

It is worth mentioning that anxiety is complex and multi-factorial. There are many systems in the body that could be experiencing a disturbance or pathology: musculoskeletal, neurological, biochemical, electrical, energetic and others. However, in my experience I have found the following to be true for many people: anxiety disturbs our mind-body connection, scrambling our interpretations as to what is actually happening at the moment. Mindfulness and body awareness, in my experience, are some of the natural enemies of anxiety. The more we can connect to our bodies and truly pay attention to what we are feeling, the more we can understand our bodily processes and even use them in our favor. Using our bodies to self-soothe is obviously not a new idea – as children we did this all of the time. In many photos of me as a little girl, I am staring distrustingly into the camera, either twirling my hair or sucking my thumb. As an adult, however, I clearly needed smarter tactics! Somatic therapy, yoga and massage help, but what about tools to help in a pinch during a stressful moment? Here are a few that work for me – I hope you find one or two that are helpful.

BREATHING TECHNIQUES

Breathing is a fundamental part of any discussion about anxiety. It’s a cliche for a reason! The breath is the life force. At the onset of stress, we might find ourselves momentarily freezing in place, interrupting breathing altogether. As the heart rate quickens, the breath returns but at a faster pace in the form of shallow breathing. As we continue to respond to stress, our muscles tighten, including the thoracic diaphragm and other muscles responsible for inspiration and exhalation. Our stomach muscles often tense up in order to protect our organs, making a full inhale and exhale even more difficult. Most of us, unless we have specifically done some type of breathing practice, do not take full breaths as we brace ourselves against discomfort. This, of course, leads to more panic and anxiety. So the first and best line of defense against anxiety is full, deep breathing.

In order to take a full breath, we must fill our lungs to the sides and down into the thoracic diaphragm as well as the upper part of our chest. I find it helpful to put my hands around myself in a sort of “self hug”, but down around my ribs. You can simply put your hands on your ribcage on the same side of your body, too; I just like the “swaddled” feeling I get with my arms wrapped around my middle. (It looks less conspicuous if you are in public, too.) Once your hands are on the ribcage, apply the slightest pressure and slowly breathe out into your hands as much as you can and then fully exhale. Take a few seconds each for the inhale and exhale and really pay attention to how you feel. Imagine the stress leaving your body with each exhale. Visualization is another great tool to aid in breathing. I learned these visualization techniques from Carole Osborne, one of the most respected educators in the field of perinatal massage:

Imagine your torso as a folded umbrella with the edge of the umbrella at your lower ribcage. As you inhale, see the umbrella opening. Exhaling, imagine it closed against the center pole. Continue to open and close the umbrella in your imagination as you breathe for another several minutes.

Once you are able to fill up the lungs out to the sides, place your hands on your belly OR one hand on the belly and one hand on the chest. Again slowly breathe into your hands so they are rising and then allow a full exhale. For those of us who grew up on Jane Fonda … this is not the time to be sucking in your stomach. Allow your belly to look big and round!

The visualization (again, from Carole Osborne):

Imagine that your torso is a beach and that your hands are driftwood on that beach rising and falling with the water’s peaceful movements. With your inhale, watch in your mind’s eye as your “driftwood hands” rise with a gentle wave touching the shore. Let your abdomen swell more extensively than your chest. Feel your hands sink on your torso when you exhale, as you imagine the wave retreating. Continue to watch the rising and falling of the driftwood on the gently surging and retreating water as you continue to breathe fully for several minutes.

Full, slow breathing practices are generally great for me and easy to do in public, but there are many different types of breath exercises out there. Andy Caponigro’s book “The Miracle of the Breath: Mastering Fear, Healing Illness, and Experiencing the Divine” is full of good suggestions, including a “Tarzan” breath, a rapid breath of fire and some grounding exercises.

Practicing fingerholds can help to manage emotions and stress. Hold each finger, in turn, with the other hand, holding for as long as it feels comfortable. Hold gently, but firmly. As you hold your finger, breathe in a way that feels comfortable. Many adults feel relief after 2-5 minutes per finger, and children often need to hold their fingers for much less time (30 sec. – 1 min.) for it to feel useful. You can work with either hand, and you can also work with just one or two fingers if that feels most helpful (or you don’t have a lot of time).

Key:

Thumb – tears, grief, emotional pain, feeling upset

Pointer/Index finger – fear, panic, feeling scared

Middle finger – anger, rage, resentment, feeling mad

Ring finger – worry, anxiety

Little finger – having self-doubts, not feeling good about ourselves or feeling bad

Aromatherapy and music therapy are two quick and easy ways to ameliorate anxiety. Both affect the brain. Our olfactory system directly affects the limbic system (“the emotional brain”), which affects those parts of the brain that control heart rate, blood pressure, breathing, memory, stress levels, and hormone balance. There is a reason why you inhale bergamot oil and instantly feel happy! I have used essential oils to make inhalers for friends that they can carry around with them. The inhaler essentially looks like a lipstick; inside is a cotton wick that holds the essential oils. They are inexpensive and the wick can be swapped out to use a different recipe. The recipes can be modified to be safe for children, as well. A very basic recipe using oils that many people already have is: 5 drops each of bergamot, lavender and frankincense. Here and here are two other great blends from Aromatics International, and here is a video of Aromatherapist Andrea Butje making her Anxiety Away Blend.

Another trick is to sneak headphones on and play music that you find calming. Every once in a while I wake up at 2:30am worrying about something and I can’t go back to sleep. When this happens, I put on music: whale sounds, nature sounds, singing bowls or soothing music. Even if I can’t fall back to sleep, at least I am awake and calm as opposed to awake and freaking out. Music has been used as therapy for ages. Research shows that listening to music stimulates more areas of the brain than any other human function. Among many other things, music lowers levels of the stress hormone cortisol, so it has a powerful effect on stress. According to a large scale McGill University review, listening to music prior to surgery was more effective in reducing patients’ anxiety than prescription medication. Music therapy is currently being successfully used to alleviate anxiety in patients with dementia, cancer, chronic pain and depression.

VAGUS NERVE STIMULATION

The vagus nerve plays an important part in the parasympathetic nervous system, or the “rest and digest” system. It runs from the brainstem through the neck to the heart, lungs and other internal organs – it’s amazing how many body systems this nerve is involved with (it’s name derives from the Latin word for “wandering”, if that tells you anything). It keeps the body in balance through neurendocrine-immune axis activity and the regulation of metabolic homeostasis. This nerve mediates sensory information to the brain and has direct and indirect connections to the neural circuit which pertains to emotional and cognitive functions. People with low vagal tone often suffer from depression and/or anxiety (among other things), since the ability to get into “rest and digest” is compromised. Research has been mixed, but the concensus seems to be that stimulating the vagus nerve may offer benefits, including stress reduction.

Vibration in the throat is the easiest way to stimulate this nerve. All of the below would do the trick, plus most are fun:

gargling

chanting

singing

laughing

You all know I love doing the “horselips” and it’s even better if I combine it with a low guttural noise before or after. Laughter, in this case, truly can be the best medicine. I keep a few “bloopers” style seconds-long videos on my phone for moments of panic. These videos make me belly laugh every single time and the anxiety magically lifts.

The vagus nerve responds to cold exposure, so to possibly alleviate anxiety in a pinch, you could splash cold water on your face. I haven’t tried this one specifically for anxiety, but I do enjoy a cold shower post-run and have noticed uplifting effects on my mood (which could have been the run, too).

MUSCLE DECOMPRESSION FOR TENSION RELEASE

JAW

Those of us who hold tension in our jaws will find relaxing the mouth and jaw works wonders in combatting worry and anxiety. My first step is normally to flap my lips in “raspberries” or “horse lips” fashion. I look ridiculous but I can’t believe how much doing this calms me down. I then place my hands on the sides of my cheeks, apply pressure and slowly drag down, allowing my mouth to open if necessary as my hands glide down my face. I know most people are accustomed to pulling the cheek skin up rather than down for vanity purposes, but the point is to traction the masseter muscle away from its origin. In other words, we want to apply pressure in the opposite direction of normal contraction.

SHOULDERS

It can be helpful to exaggerate a tensed posture first in order to get a better release of tension. With the shoulders, you can tense up and shrug your shoulders for three seconds and then drop the shoulders dramatically as you exhale, sighing audibly if that feels good. This one does not work for me, personally, but I have friends and clients who swear by this method of tension release. I have modified the idea in a way that works better for me: I tense my shoulders back rather than up, squeezing the rhomboids for 3 seconds, which also allows the chest to open up, and then I drop the shoulders into relaxation.

CHEST

Tightness in the chest is a common complaint accompanying feelings of anxiety. The breathing techniques above are all great for decreasing this tightness. In addition to breathing, however, I like to externally manipulate the chest (which helps to facilitate the breathing). One way to do this is to stretch the pectoralis muscles in something like a doorway stretch (blog on that here). However, when I am feeling anxious, I find that feeling contained feels better, again like swaddling. Anxiety is individual, so you can experiment and see what feels best for you. I like to put one or both hands over my sternum. I can feel my heart and lungs, which makes me feel very safe. This also connects me to my heart center, reminding me of my gratitude practice. I then put the slightest pressure on my sternum, just enough to get good traction on the skin, and I move the skin around in slow big circles, or sometimes just move the skin laterally and hold for a few moments and then do the other side.

I will admit that I do not fully understand the mechanism through which this might work, but it does (for me). As skin stretch is the major modality used in dermoneuromodulation, I suspect the answer may be found here. A very simplified version of this theory is that by engaging mechanoreceptors in the skin through skin stretch, we are giving the nervous system input that helps it downregulate nociception. By providing the cutaneous nerves with novel stimuli, we are affecting the nervous system in a broader sense. I have only begun to scratch the surface of Diane Jacobs pivotal work, so forgive the crude explanation. All I can say with certainty is that a slow gentle skin stretch on the sternum greatly reduces a sense of panic in me personally, and I use it often. You can try it and decide for yourself if it helps.

GROUNDING YOURSELF

Making ourselves feel “safe” appears to be a big factor in alleviating anxiety. One way to do this is to feel that we are on solid ground, bringing us back to “earth”. Connecting with the natural earth, if it’s available to you, is best, but even feeling the floor in your office beneath you can be reassuring. A few suggestions for feeling grounded:

walk on grass, barefoot if possible (watching out for dog poop, glass, etc)

stomp your feet on the ground to feel how solid it is beneath you, knowing you are supported

put your back up against a wall, again so you feel supported, with something to “lean” on

SUPPLEMENTS

As supplements are outside of my scope of practice, I asked genomics expert and functional medicine practitioner Ryan Frisinger if he had any safe over-the-counter supplements to combat anxiety. He gave me a GABA spray (that included things like L-Theanine, L-Carnosine, and pterostiblene) that worked great for me, taken before bed to wind down or anytime I felt stressed, but he cautioned me that it was not for everyone. The spray worked with my particular genetics, but could be harmful to someone else. He suggested Hyland’s Biochemic Phosphates, which are specifically formulated for anxiety and nervous system exhaustion and generally safe for everyone.

However, he was clear that anxiety is complicated and deserves a more thorough examination. Here is what he said:

A lot of anxiety is driven by foods that are excessive in tyrosine, tryptophan, sulphur and methione. All of those have the potential to activate the fight or flight response and imbalance neurotransmitters. The first step is to eat an anti-inflammatory diet: no grains, dairy or sugar. Additionally, many things in our modern medicine toolkit cause antibodies to the GAD enzymes, which make it hard for the body to change glutamate into GABA to help move the brain from a state of excitation to inhibition. We must also look at broad scale nutrient deficiencies (B-vitamins, magnesium, zinc, vitamin D, lithium orotate, vitamin C), because the biochemistry of the brain is downstream and if there is an insufficient supply of nutrients, we have uneven production of neurotransmitters. There are lots of supplements on the market that propose cures for anxiety like nervines (passionflower or Kava), or GABA sprays and capsules (Kavinace). Most of those are too generalized to treat anxiety effectively as the problem is always multifactorial in nature. It is also important to draw a distinction between anxiety and depression. Monitoring sleep quality is crucial because that will undermine the neurotransmitter system’s function and the circadian biology of the cells and organs. Finally, we need to be mindful not to overstep energetic boundaries, as some of this anxiety is caused by lifestyle choices that lead to chronic exhaustion of the nervous system.

I couldn’t agree more: diet, sleep and lifestyle are the areas to target when thinking about optimum functioning, which includes nervous system and emotional states. Until we have these dialed in, however, we need little tools to get us through stressful times. When I pressed him for a short-term suggestion to combat acute stress, he emphasized the importance of reengaging the brain to stop the spiral of anxiety. (That will be the subject of another post in the near future.) He agreed with all of my suggestions above, with the walk in nature being his top go-to, but added that 10 minutes of Tetris is HIS quick way to halt anxiety/panic attacks in their tracks. (If you are intrigued and want to hear more about Ryan’s work, I have listed some podcasts in the resources below).

These are just a few of the tricks I have learned along my journey of self-knowing. When I start to go down the spiral of worry, fear and panic, I try to be as compassionate with myself as humanly possible. None of these tricks works for me EVERY time, except for maybe the breathing techniques, but the more I develop body awareness, the more I find I can handle my stress with equanimity.

This is the second part of a two-part post about strengthening the musculature in the posterior neck and shoulder region. Please read part 1 for the reasoning behind why this may help ease discomfort in this area (and for ideas on how to strengthen your rhomboids). This post will focus on a muscle we all know well … the upper trapezius! Many, many of us experience some type of discomfort in the upper part of the shoulder. We often attribute this sensation to tightness in the upper trapezius. However, I have found that stretching and massaging those fibers rarely provides any lasting benefit. Both of these interventions feel great and increase body awareness, which is one of the most important aspects of healing. In terms of prolonged benefit, however, I haven’t had much success. (Stretching and massaging the muscle directly beneath the upper trapezius, levator scapulae, is a different story altogether – this works wonders, and will be the subject of another post in the future.)

Yet, there is something going on with this muscle in many of my clients, as they exhibit the typical pain referral patterns and “question mark shaped” headaches associated with it.
Like the rhomboids, clients often feel a tautness in the upper trapezius accompanied by a constant throbbing sensation, suggesting that it is probably weak and overstretched rather than “tight”. Again, in these cases, clients will benefit more from strengthening than stretching.

ANATOMY & PHYSIOLOGY:

The trapezius is a large, superficial muscle that connects the collarbone and shoulder to the entire cervical and thoracic spine. The part I am concerned about in this post is the upper trapezius, which originates on the occiput, ligamentum nuchae in the neck and the spinous process of the C7 vertebra (some sources say all 7 vertebrae, some say just the connective tissue and C7). It inserts into the lateral third of the clavicle. In other words, it runs from the base of the skull and the fascial fibers in the back of the neck to the outer portion of the collarbone. There is some controversy as to the function of this muscle, and it is hard to separate the upper fibers’ function from the rest of the muscle. All of the fibers work together, although during different actions some areas of the muscle work harder than others. The standard anatomy answer is that the upper trapezius is a prime mover of scapular elevation, which means it raises the shoulder blade. However, there is some excellent research (see resources below) to suggest that, due to the transverse direction of the upper trapezius fibers, its main function is to move the clavicle medially, thereby transferring compression loads from the cervical spine to the sternoclavicular joint (where the collarbone meets the sternum). This essentially means that the weight of the arm and anything it carries is transferred to the chest and mid-body rather than the neck. Pretty important! It would make sense then that if this muscle is weak, we might have some neck pain. This also makes the case for strengthening.

It is worth mentioning again that movement is complicated and muscles perform various functions to varying degrees, depending on the orientation of the body. In this case, the upper trapezius DOES perform scapular elevation and upward rotation in conjunction with serratus anterior, once the movement is already started. It appears to be strongest when the arm is already slightly raised away from the body in abduction. We can use this to our advantage, as it gives us an easy movement to perform in order to strengthen the upper trapezius! The added benefit is that any overhead exercises eliminate the action of the levator scapulae, which is already overworked in most people.

Just as in my rhomboid post, these exercises are general suggestions. Unless you have specifically done these before, or are familiar with exercise physiology, please consult a personal trainer prior to incorporating these into your exercise regimen. It is important to start with the lightest weight (or no weight) first to make sure you have the proper form and to move slowly and gently (NO jerky movements). Always pay attention to your breathing during any movement – the general rule being exhale upon exertion. Finally, if you google these you will find some conflicting information. Many trainers and physiotherapists think that, “in general”, upper traps need to be stretched rather than strengthened. In addition to anything you may find on your own, I urge you to read the resources I have included at the bottom of the post and then make your own decision as to what you think might be happening with your shoulders.

Here are two exercises for strengthening:

OVERHEAD SHRUG

The overhead shrug is a great exercise for the upper trapezius, provided you do not have a problem with shoulder mobility (in either flexion or abduction). Start without weight just so you understand the motion. Lift your arms directly above your head (from a standing or seated position, but I prefer standing), with slightly bent elbows. From that position, reach your arms more toward the ceiling and perform a shrugging motion. In the video below, her arms are straight, but I think it’s better to do them with slightly bent elbows like the picture above (forearms are still perpendicular to the floor, this is NOT a Y-shape). Ask a personal trainer which might be better for you. Some things to notice:

Make sure your ribcage is not flared out when your arms come up. If it is, use lighter weight, OR you may need to work on your shoulder mobility for a few weeks prior to attempting this exercise. For the yoga people, let yourself hang out in a child’s pose for a few minutes daily until your shoulders can more easily go overhead without the rib flare.

Make sure you are solid in your core as your arms go up.

Make sure you are breathing properly.

If you do not like overhead movements and choose to do standard shrugs instead, I like Adam Meakins’ “Monkey Shrugs”. In order to properly engage the upper trapezius, your arm can not be in a neutral position; it must be in at least 30 degrees of abduction (away from the body). So he suggests taking weights in your hands with your arms at your side, sliding your hands up to about waist level and shrugging from THAT as your starting position. This will ensure that you are working the upper trapezius.

WALL SLIDES

This exercise is excellent for upward rotation, which is a problem for many of us. It works both upper trapezius and lower trapezius. The photo and description are from flexibilityrx.com

Begin with your forearms in contact with the wall, shoulder width apart. The elbows are bent at ninety degrees and wrists in line with the elbows. Keeping your forearms in contact with the wall – slide your arms up and out – without shrugging the shoulders. Controlling the lower part of the shoulder blade with the lower trapezius helps prevent the shoulders from elevating during the movement.

I use the term ‘pack scapula down’ – not to describe a rigid position – but a controlled retraction of the scapula during its upward rotation (see illustration). Focusing on lower trapezius engagement as the scapula rotates out to the side creates this position of dynamic stability.

Integrating Lower and Upper TrapeziusAt the top of the movement – with the arms extended, pull the arms back 2-inches retracting the shoulder blades (part B). A slight shrug while pulling the arms off the wall engages the upper trapezius for full upward rotation. Note – the shoulders remain relaxed down as the arms slide up and out (part A), before a shrug is added at the top position to pull the arms back (part B).

This motion is similar to an overhead barbell shrug where a shrug at the top of the lift is used to enhance upward rotation – as the scapula is controlled by the lower trapezius. This timing of lower and upper trapezius activation takes some practice – the initial focus should be upward rotation without elevating the shoulders (part A of the exercise).

After pulling the arms back off the wall (part B) return the arms to the wall and slide them back down to the starting position – maintaining contact with the wall (part C).

Some things to notice:

As your arms slide up the wall, make sure you are not making a circle and bringing them together – the point HERE is to go out into a Y shape.

Make sure your hands are not turning inward into medial rotation as you slide up. The outside of your hand should remain in contact with the wall.

“The Upper Traps: Overassessed, Overblamed and Very Misunderstood”, Meakins, Adam (DISCLAIMER: This man is a sports physiotherapist and makes some brilliant points. However, his personality is caustic and he is completely against manual therapy. In my opinion, he takes a very simplistic view of the benefits of manual therapy and does not respect the gains to the nervous system and the importance of fostering body awareness. While I fundamentally disagree with his views on manual therapy, I still very much respect his knowledge of sports physiotherapy!)

As I mentioned in my last post, neck and shoulder pain are among the most common reasons for clients to seek out massage therapy. In a perfect world, we would be able to engage in a wider variety of movements as well as getting in MORE movement throughout the day, including dynamic stretching. Recruiting all of the muscles in non-repetitive ways is easier on the body and should keep musculoskeletal complaints to a minimum. However, this is not always possible. Sometimes we just need simple stretches or exercises to help us “do the best we can”, since we spend too much time in one static position given our biomechanical environment. It is worth repeating that there is no “ideal” posture, but some postures are much easier on the body than others. Particularly in the case of forward head posture, alignment does matter. Barring injuries and other acute situations, the majority of us with just the standard discomforts due to forward head posture could benefit from three basic concepts:

a) getting the head aligned over the neck (not in front of it),

b) stretching the anterior musculature, and

c) strengthening the posterior musculature.

There is obviously A LOT more to consider, but these little basics are a great start. I have already written about getting the head on the neck and stretching the muscles in the chest and on the anterior part of the shoulder blade. The next step is strengthening the muscles in the back of the neck and shoulders that are being pulled taut and causing discomfort, specifically the rhomboids and the upper trapezius. This will be a two part blog post – the first will address the rhomboids and the second will address the upper trapezius. I will give some basic suggestions, but please CONSULT WITH AN EXERCISE PROFESSIONAL prior to trying any of these exercises if they are new to you or if you have injuries.

RHOMBOIDS: ANATOMY & PHYSIOLOGY

The rhomboids are a set of four muscles (two on each side) in the mid-back. They lie deep to the trapezius muscle, but not as deep as the erector group running along each side of the spine. Rhomboid major and minor together originate on vertebrae C7-T5 and the bottom of the ligamentum nuchae in the neck and insert on the medial edge of the scapula.

In other words, they connect the shoulder blade to the spinal column. Together they are responsible for stabilization, retraction, elevation and inward rotation of the scapula. The shoulder blade needs the ability to be stable with reference to the spine in all different planes of motion, as it is the anchor for many of the muscles that move the arm. For the same reason, however, it also needs the ability to perform fluid movement. In addition, as the arm moves, it needs room in the shoulder socket for the head of the humerus, or arm bone, to move. In order for the room to be created, the scapula, the coracoid process of the scapula (the bony protrusion of the shoulder blade in front of the shoulder) and the clavicle must all move together in a seamless motion. Needless to say, there is a lot going on in the shoulder girdle!

There are fifteen other muscles all attached to the scapula, in addition to the rhomboids, with lines of pull in all different directions. Given the main movements and postures that most of us engage in, the rhomboids often end up acquiescing to the “hunch club” we discussed before: pectoralis minor and subscapularis. This can put the rhomboids in a perpetual eccentric contraction (ie “putting on the brakes”) and make them overstretched, which is why so many of us have discomfort there. We think of them as being “tight”, but I think that word implies contracted or “the opposite of loose”, which is not quite right. Really the muscles are often “taut”, which is more like being pulled to the point of weakness. (I have my good friend, Ed Buresh, to thank for helping me find a better word to explain this.) Given that these muscles are overstretched, stretching them out is not very helpful. What really helps is strengthening them! Here are a few basic exercises to strengthen the rhomboids, but there are many variations that work and switching it up is always the best medicine – ask your personal trainer which exercises are best for you. As with every exercise, make sure your core is stable and you are not holding your breath (general rule: exhale on exertion).

BAND PULL-APARTS

This is a great exercise and is easy to do, even when traveling, as all you need to have with you is a band. The bands range from “easy” to “this-thing-barely-moves-it’s-so-hard”, so you can do this exercise whether you are a novice or a serious athlete. You simply start by holding the band out in front of you, as in photo (A). Slowly pull the band apart using your rhomboids until your arms are out to the sides, as in photo (B). Work your way up to two to three sets of fifteen repetitions, with rest or different exercises in between. Some things to keep in mind:

1. Arms should be straight. If the arms start to bend, your band is too tight – try a looser one to start.

2. Shoulders should remain relaxed and down. Again, if your shoulders are hunching, you are not maximizing your rhomboids. You can either do it in front of a mirror (what my trainer forced me to do), so you can correct your shoulders if they start sneaking up, OR start with an easier band.

There is no shame in starting with the lightest band – we have to meet ourselves where we are NOW, not where we were when we were marathon running (note to self), and not where we secretly want to be. Part of this whole process is seeing if we can get our bodies comfortable and mobile again after probably a lifetime of discomfort and immobility. This takes time to do safely. I always revert to writing in “we” form when not giving specific “instructions” (for lack fo a better word) because I am in this process, too! “Progress not perfection” is something I repeat to myself at least once a day but often more. It helps 🙂

3. The form in the photo shows the arm in medial or inward rotation, which is how we normally are, with subscapularis contracted. In order to stretch subscapularis and strengthen the lateral rotators (infraspinatus and teres minor) instead, you can do the 2.0 version: this involves changing your hand placement so the palms are facing each other and thumbs up, or even having the palms slightly up and the thumbs slightly out to the sides. This way as you pull out, you are in lateral rotation instead.

4. Don’t forget your breathing.

REVERSE FLYES

There are various ways to do this one, but this is the most comfortable for me. You hinge at the hips, with the back straight, arms down in front of you holding weights (as in the faded part of the above photo). You lift the arms straight out to the sides, contracting the rhomboids, until they are at shoulder level. Work your way up to two sets of twelve repetitions, with rest or different exercises in between. Some things to keep in mind:

1. Make sure you are in a proper hip hinge with your back straight. There should not be any flexion in your thoracic spine (in other words, the back should not be bent over in the middle). The head should be comfortable and neutral, eyes focused on a point on the floor in front of you. If you need to look up into the mirror in front, do so for one rep, but then make sure to put your head back into neutral position.

2. That said, there shouldn’t be too much extension or arch in the back, either. You need to be forward enough to actually engage your mid-back; otherwise, you are engaging the wrong muscles. In other words, it’s NOT this (see the area in yellow? That’s mainly the middle deltoid that is being worked here, not the rhomboids):

3. There are many variations you can do: with different objects (although the objects should be heavy enough to feel challenging after twelve reps), with bands or on an incline bench if that’s more comfortable for the back. See the photos below.

4. Don’t forget your breathing.

ROWS

Rows target multiple muscles, including rhomboids, and can be done seated or standing.

The seated row (photos above): begin by sitting on the bench and grasping the cable grip attachment. Sit upright, straighten your lower back and slide your hips back slightly. As you pull the attachment toward your waist, pull your shoulders back and squeeze your shoulder blades together. Hold that squeeze for an extra second to activate the rhomboids more specifically. Work up to three sets of twelve repetitions, with rest or different exercises in between. Remember to keep your back straight and to breathe.

The bent-over dumbbell row (photos above): Set up in the same manner as you would for the reverse flyes above. You can hold the weights with palms facing one another or palms up as in the photo above. Rather than moving arms out to the sides as in the reverse flyes, for this exercise you simply bend your elbows and pull your arms straight back until your wrists are at your sides. In order to activate the rhomboids more specifically, squeeze the shoulder blades together at the top of the movement and hold for an extra second. Work your way up to three sets of twelve repetitions, with rest or different exercises in between. Remember to keep your back straight, head neutral and breathe.

In the next post, we will highlight the upper trapezius muscle, another muscle which often gives people discomfort. Like the rhomboids, there is great evidence suggesting that strengthening rather than stretching this muscle leads to relief. Stay tuned 🙂

**BONUS EXERCISES**

FOR THE ATHLETES OR PEOPLE WORKING WITH TRAINERS (ONLY):

T-BAR ROWS

My trainer used to love this one – mostly for latissimus dorsi and teres minor, but it works the rhomboids as well. Please do not try this exercise for the first time without a trainer. Again, it’s a hip hinge with the back straight. This time the angle of the back to the floor is slightly larger, so you are able to look forward with the head still in neutral. The weight is shifted back onto the glutes. Start in the position in the first photo with the bar on the ground, and lift until the bar is at your chest as in the second photo. As you lift, your upper body lifts slightly as well (notice the difference between her body placement in the two photos). The great thing about this exercise is that it works many of the posterior chain muscles from back to legs.

BENT OVER BARBELL ROWS

This is another good one to work many of the muscles in the back. Again, please do not try this one for the first time without a trainer’s supervision. You can do it with a backwards grip or split grip, but I like the palm-forward grip like in the photo. Again, you hinge slightly at the hips, keeping the back straight and head in neutral.

Neck and shoulder pain are among the most common complaints reported by new clients. Recent developments in pain science have largely debunked purely structural models as explanations for pain. However, structural analysis is still relevant as a piece of a larger paradigm, particularly when it comes to the neck and shoulders. So while biomechanics may not be everything, in most cases of neck and shoulder complaints, consistent forward head posture greatly contributes to the root cause of the pain. In some of these cases, there is an accompanying uncomfortable “dowager’s hump” at the base of the neck that forms when the vertebrae become compressed. Neurological overstimulation can also result from sustained tension in the suboccipital muscles on the first two cervical vertebrae, causing headaches, anxiety, dizziness and other related symptoms. Additionally, jutting the head forward places incredible tension on the muscles below the jaw, as the body is using the jaw to pull back on, and counter the weight of, the head. This can manifest as neck tension or TMJ. Given that many of our daily activities involve staring straight ahead, it’s not a surprise that our heads tend to gradually lean forward on our necks rather than sitting upright fully supported by the spine.

A simple chin tuck can gradually reverse this development, and it actually feels great to do. I show this exercise to almost all of my clients, and I do it daily myself, particularly when I find myself hunched over the wheel while driving. Tucking the chin elongates the muscles in the back of the neck and can relieve nerve compression by creating more space on the back side of the vertebrae, where the nerves exit. This position can relax the jaw and the front of the neck, too, particularly if you use your finger to support your jaw. The most basic version involves simply backing up your head and rotating it slightly forward so you are tucking your chin into your neck. You will end up with a “double chin” type of effect. You should feel a pleasant stretch at the back of your neck. If you are chronically in forward head posture, you might even feel a rush of sensation up your neck and into your head. If it feels easier, you can use your finger to push your head back. It looks like this:

You can also stand with your back up against a wall, with your feet resting up to 12 inches away from the bottom of the wall. When you tuck your chin, you can aim to rest the back of your head against the wall, slightly moving your head up along it. If you are still having trouble, you can start out doing this exercise while lying down in a supine, or face up, position. You can hold the Chin Tuck for 5-20 seconds and repeat it 5-10 times throughout the day. Pay attention to your shoulders and ribcage while you do this; they should remain neutral. If you find yourself raising your shoulders or flaring your ribcage up, reset your body and try it against the wall or lying down until you can keep those in a more neutral position. I learned an advanced version of the Chin Tuck from one of Erik Dalton‘s newsletters a few months ago and I love the added benefits! So, when you are ready for 2.0, you can add a little myofascial drag to your Chin Tuck. Simply place your hand gently on your sternum, so that your thumb is on the innermost part of the clavicle on one side and your fingers are on the innermost part of the clavicle on the opposite side. Place your other hand on top of that hand, and as you tuck your chin, you drag the skin slightly downward. This creates even more of a stretch in the anterior neck muscles. The steps look like this:

The final step is to hold the myofascial drag, turn your head to the left, tuck your chin, and then repeat on the other side. If you want to follow along to a visual, I made this incredibly dorky video since I couldn’t find any on the internet: Chin Tuck Video

After a few months of doing this exercise, most clients report a decrease in neck and shoulder tension. Honestly, I attribute this at least partially to better body awareness, as doing this exercise makes it evident how far forward we are normally carrying our heads. It also makes us pay attention to how uncomfortable the forward head position is and how much better the head feels on top of the spine instead of in front of it.